| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $100.82 | $100.82 | $100.82 | |
Midlands
| Professional | $97.52 | $97.52 | $97.52 | |
Wellmark
| Professional | $81.20 | $81.20 | $81.20 |
Unspecified Periodontal Procedure, By Report
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $100.82 | $100.82 | $100.82 | |
Midlands
| Professional | $97.52 | $97.52 | $97.52 | |
Wellmark
| Professional | $81.20 | $81.20 | $81.20 |